Objective To summarize the perioperative experience of nursing the middle-aged and elderly patients of lumbar spinal stenosis and degenerative lumbar scoliosis treated with posterior or transforaminal lumbar interbody fusion. Methods Posterior or transforaminal lumbar interbody fusion was performed in 69 middle-aged and elderly patients with lumbar spinal stenosis and degenerative lumbar scoliosis. Nursing measures included evaluation and treatment of complications, preoperative guidance for surgical body position, and postoperative close monitoring, treatment of complications and functional exercises. Results The operation on all the 69 patients was smooth, with surgical time ranged from 3 to 7 hours and bleeding volume between 300~750 mL. Postoperatively, 9 patients suffered from CSF leaks, 3 ones had a screw loose by imageology, 2 did from pneumonia, 2 did from DVT, and 3 did from depression. After clinical management and nursing, all the patients were cured and discharged. Conclusions Meticulous clinical treatment and nursing of preoperative complications and instructions on body position are the foundation for successful surgeries. Postoperatively, close monitoring, management of the complications and the instruction on functional exercises are guarantees for the successful surgeries.

Objective: To establish an HPLC fingerprint spectrum of Mongolian medicine Rubus sachalinensis. Methods: An HPLC was performed on the column of phenomsil ODS (250 mm × 4. 6 mm,5 μm) with the mobile phase of 0. 3% phosphoric acid-MeOH with gradient elution at a flow rate of 1. 0 ml·min-1 ,the detection wavelength was 290 nm, the column temperature was 25 ℃and the injection volume was 20 μl. Totally 7 batches of Rubus sachalinensis from different habitats were analyzed. Results:The RSD of relative retention time of the common peaks of Rubus sachalinensis was less than 3%, and that of relative peak areas was below 3%as well, which were in accordance with the requirements of fingerprint. Conclusion:The established HPLC fingerprint has promising accuracy, repeatability and stability, which can be used as one basis for the quality control of Rubus sachalinensis.

Hemophagocytic lymphohistiocytosis(HLH), also known as hemophagocytic syndrome(HPS), is a hyperinflammatory syndrome caused by multiple etiologies.Interferon-γ(IFN-γ)has been reported to play a key role in the pathogenesis of HLH, and antibody against IFN-γ(emapalumab)can be used to treat HLH.Here, the findings on the role of IFN-γ in pathogenesis and emapalumab in treatment of HLH are reviewed respectively.

The essay discussed the necessity and essentiality of medical moral education to intern,in the background of market-oriented economy.To summarize ways of medical moral education to intern.

Objective To investigate the feasibility of differentiation between prostate cancer and prostatitis by using metabolic ratios provided by 3D 1H Magnetic Resonance Spectroscopic Imaging (MRSI). Methods Metabolic changes were evaluated in 42 voxels with prostate cancer and 30 voxels with prostatitis in the peripheral zone using MRSI. The results were based on the pathologic findings by biopsy. The (choline + creatine)/Citrate (CC/C) ratio and the changes of choline and citrate levels were evaluated in each voxel with cancer or prostatitis, t test was used to determine the power of the CC/C ratio in differentiation between prostate cancer and prostatitis. Results The CC/C ratio for cancer voxels (1.28±0.41) was significantly different from the ratio in the voxles with prostatitis (1.03±0.40), t=6.45, P<0.05, due to greatly increased choline level in the cancer voxels. When CC/C ratio of 0.8 was taken as the criteria for the diagnois of prostate cancer, the sensitivity, specificity and accuracy were 65.5%, 71.4% and 66.7%, respectively. Positive predictive value(PPV)and negative predictive value(NPV) were 90.5% and 33.3%, respectively. The CC/C ratio was higher than 0.86 in 66.7% voxels with prostatitis (20 voxels of total 30 voxels), which mostly depended on the level of choline. When citrate level was used as an auxiliary index to evaluate prostatitis (Cit/norm, Cit≥0.75), the misdiagnosis rate of prostate cancer was reduced to 26.6%(8 voxels of total 30 voxels). Conclusions The metabolic ratio of CC/C can be used to differentiate prostate cancer from prostatitis. The misdiagnosis rate is reduced when citrate is not or slightly decreased relative to normal citrate level (Cit/norm, Cit≥0.75).

Abstract: Objective　To understand the characteristics of mutations associated with resistance among 72 multidrug-resistant tuberculosis (MDR-TB) strains using whole genome sequencing (WGS) and to evaluate the performance of WGS for predicting MDR-TB drug resistance. Methods　The clinical strains isolated from patients who visited the outpatient department of Tianjin Center for Tuberculosis Control from January to September in 2020 were collected. Identification tests using p-nitrobenzoic acid (PNB) medium were performed. Drug susceptibility tests (proportion method) on L-J medium were performed. After excluding duplicate strains, 72 MDR-TB strains were selected for WGS. Data were analyzed by using online databases and the phenotypic drug susceptibility test results were compared with resistance profiles predicted by WGS. Results　All of 72 MDR-TB strains belonged to linage 2, and there was no significant difference in rate of pre-extensive drug-resistant tuberculosis (pre-XDR-TB) between modern type and ancestral type (χ2=0.287, P=0.592). A total of 81 mutation types were found from resistance-related genes for 12 anti-tuberculosis drugs, and the common mutation types in different drug-resistant strains were: streptomycin (SM): rpsL Lys43Arg; isoniazid (INH): katG Ser315Thr; rifampicin (RIF): rpoB Ser450Leu; ethambutol (EMB): embB Met306Val; ofloxacin (OFX), levofloxacin (LFX), moxifloxacin (MFX): gyrA Asp94Gly; kanamycin (KAM), capreomycin (CAP), amikacin (AMK): rrs 1401a>g; para-aminosalicylic acid (PAS): folC Ile43Thr. Nine mutation types were found in 9 prothionamide (PTO)-resistant strains, one type for each strain. The sensitivity and specificity of WGS for predicting resistance to different drugs were SM: 98.15% and 88.89%, INH: 90.28% and -, RIF: 98.62% and -, EMB: 79.49% and75.76%, OFX: 97.30% and 85.71%, KAM: 85.71% and 98.46%, PAS: 27.27% and 95.08%, PTO: 81.82% and 60.66%, CAP: 60.00% and 98.51%, LFX: 97.22% and 83.33%, MFX: 97.30% and 85.71%, AMK:100.00% and 100.00%, respectively. Conclusion　WGS is a rapid and promising method which has high consistency with the phenotypic drug sensitivity test. Therefore, it has good application prospects in predicting drug resistance in MDR-TB.

Objective To explore whether the glomerular podocytes can be damaged by aristolochic acid. Methods Thirty-two male SD rats were equally divided into the following 2 groups:model group in which the rats received the extract of Aristolochia manshuriensis Kom (AmK) by gavage; control group only received tap water by gavage.24 h urinary protein excretion was measured at the end of the 1st and 4th week,and SDS-PAGE gel electrophoresis was performed to detect the protein in urine.At the end of the 4th week,all the rats were sacrificed and the glomeruli were isolated by laser capture microdissection technique.The mRNA expression of nephrin,podocin,CDA2P,podocalyxin and podoplanin in isolated glomeruli was determined by RT-PCR,and the average width of glomerular foot process was measured by electron microscopy and image analysis. Results At the end of the 4th week,24 h urinary protein excretion in the model group was significantly higher than that in the control group (P＜0.01) and the urinary albumin content in model group was also obviously increased.The average width of glomerular foot process in the model group was significantly larger than that in control group (P＜0.01).The mRNA expressions of nephrin,podocin,CDA2P,podocalyxin and podoplanin in glomeruli were significantly down-regulated in the model group compared with the control group,which decreased by 34％,62％,56％,50％(P＜0.01) and 27％ (P＜0.05),respectively. Conclusions Aristolochic acid can damage the glomerular podocytes,resulting in the down-regulation of nephrin,podocin,CD2AP,podoplanin and podocalyxin mRNA expression, the segmental widening of foot process, and increased urinary protein excretion.

Objective To investigate the inhibitory effects of Argatroban on the instant bloodmediated inflammatory reaction(IBMIR)after islet transplantation.Methods Rat islets were isolated and purified rat islets,and were divided into blank control group,control group and experimental group.In the control group,the blood and the islets were directly mixed,and in the experimental group the Argatroban was added to the mixture based on the control group.while the blank control group was added with blood alone without the islets.Each group was reacted at 37℃for 60min,and then the content was filtered through trap valve of 70 μm.The residual thrombus and tissues were filtered by the trap valve in both the experimental and control groups,detected by the thinprep cytologic test(TCT),and the filtrate received blood routine test,and the function of islet was determined using insulin releasing test.Results The number of blood platelets,white blood cells,mononuclear cells,and lymphocytes percentage in the experimental group were significantly higher than in the control group after 60 min(P＜0.05).Under the environment of the high and low concentrations of glucose,the insulin release in experimental group was significantly increased as compared with the control group,and the insulin release index of former was 2.25±0.18,significantly higher than that of the latter 3.36±0.18(P＜0.05).The residual thrombus and tissues had few islet cells in the control group,the structure was damaged seriously,the capsule was not intact,and there were a large mumber of micro-thrombosis around the islets formed by red blood cells.But there were a large number of islet cells in the experimental group.the structure was intact in a mass,and no obvious micro-thrombosis around the islets was found.Conclusion Argatroban can effectively inhibit IBMIR in vitro,and alleviate the damage to the islet cells.

Objective To further study the value of MR T2WI fat saturation sequence in acute Spinal Trauma. Methods 109 cases of acute Spinal Trauma underwent MR imaging were analysed retrospectively. The detection rate of lesions with bone marrow edema, Vertebral fracture and spinal cord injury was compared in T2WI and FS T2WI. Results FS T2WI could detect more lesions of obscure fracture and bone marrow edema than that in T2WI,and it could accurately show the extent and the feature of anatomic structure in acute injury of bone. Conclusion FS T2WI can improve the diagnostic sensition and accuracy in Spinal Trauma, and it should be used as a routine MR sequence for detecting Spinal Trauma.

Objective To explore the clinical application and value of endoscopic surgery in the treatment of hypertensive cerebral hemorrhage assisted with neuronavigation,we compared it with traditional craniotomy.Methods We collected hypertensive cerebral hemorrhage patients with the application of neuronavigation assisted endoscopic surgery from January 2012 to November 2015,and randomly selected 30 cases as experimental group;and collected hypertensive cerebral hemorrhage patients with craniotomy and then randomly selected 30 cases as the control group.What did we respectively record about the two groups were postoperative GCS score,skin incision length,operation time,bleeding volume,length of stay,postoperative complications,and KPS score of the postoperative follow-up of sixth months;after that,the dates of the two groups were compared and analyzed.Results Compared the experimental group to the control group,postoperative GCS score did not achieve statistically significant difference (P ＞ 0.05);in the skin incision,there was statistically significant difference between two groups (P ＜ 0.05),the average incision length in the experimental group was (4.25 ±0.44) cm,however it was (13.27 ± 1.01) cm in the control group;as for the operation time,it was averagely (93.93 ±21.04) min for the experimental group,and (176.50 ± 35.65) min for the control group,there was statistical difference between two groups (P ＜0.05);with regard to the amount of intraoperative bleeding,the mean amount in the experimental group was (69.83 ± 23.83) ml,and (196.17 ± 33.83) ml in the control group,the difference was statistically significant (P ＜ 0.05);and the average hospitalization days for the test group was (13.33 ± 1.79) d,(16.20 ± 4.31) d for the control group,it was considered statistically significant (P ＜ 0.05);in complications,the test group incidence was significantly lower than that in the control group,the difference between the two groups has statistical significance (P ＜ 0.05);after postoperative follow-up of 6 months,we found that the prognosis of experimental group is better than that of control group,and statistical significance was described by analyzing the KPS scores of two groups (P ＜ 0.05).Conclusions Neuronavigation assisted endoscopic technique in the treatment of hypertensive cerebral hemorrhage has many advantages,such as accurate localization,direct vision,perfect hemostasis,and less bleeding.It is minimally invasive and can also shorten the operation time as well as lengths of stay.Besides,it can reduce the incidence of complications and bring better postoperative recovery.